The value of intraoperative point-of-care urinalysis to predict positive urine cultures and symptomatic postoperative infections during cystoscopic procedures for pediatric patients
DOI:
https://doi.org/10.5489/cuaj.9381Keywords:
Urinalysis, urinary tract infections (UTI), positive urine cultureAbstract
INTRODUCTION: We aimed to evaluate intraoperative point-of-care urinalysis (UA) for predicting positive urine cultures and postoperative urinary tract infections (UTIs) in children undergoing cystoscopy, and to assess its potential to reduce unnecessary cultures and antibiotics.
METHODS: In this retrospective cohort at a tertiary pediatric urology center (August 2023 to April 2024), 62 cystoscopy cases with paired dipstick UA and quantitative culture were analyzed after excluding recent antibiotic use or incomplete data. Dipstick markers — leukocyte esterase and nitrite — were evaluated alone and combined (“either positive” vs. “both positive”). Positive culture was defined as ≥105 CFU/mL; postoperative UTI required fever, clinical signs, and a positive culture within seven days. Diagnostic accuracy was assessed by receiver operating characteristic (ROC) curves and χ² tests. A multivariable logistic regression adjusted for age, sex, procedure, laterality, and clinical condition. A retrospective quality improvement (QI) model estimated reductions in culture orders and empiric antibiotics.
RESULTS: Thirty-nine patients (62.9%) were dipstick-negative by the “either positive” rule; one had a positive culture (negative predictive value [NPV] 97.4%; 95% confidence interval [CI] 86.5–99.9). Of 23 dipstick-positive patients, 13 (56.5%) had positive cultures. In multivariable analysis, “either positive” dipstick was the sole predictor of culture positivity (odds ratio [OR] 330.2, 95% CI 30.5–3 574.1, p=0.003). QI modeling indicated that restricting cultures to the 23 dipstick-positive specimens would have averted 39 of 62 cultures (62.9%), at the expense of missing one infection (2.6% of uncultured cases).
CONCLUSIONS: Intraoperative dipstick UA reliably identifies pediatric cystoscopy patients at low risk for postoperative UTI, offering a rapid, cost-effective tool to enhance antimicrobial stewardship and reduce laboratory use. This single-center, retrospective study with a modest sample and low event rate may be limited in its generalizability. As such, prospective, multicenter validation is warranted.
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